Schraube P, Schell R, Wannenmacher M, Drings P, Flentje M
Radiologische Universitátsklinik, Heidelberg.
Strahlenther Onkol. 1997 Jul;173(7):369-78. doi: 10.1007/BF03038240.
The most important side effect in radiotherapy of lung cancer is pneumonitis. The incidence of pneumonitis was evaluated in a retrospective study in the patient collective of the University of Heidelberg. Therapy related and therapy independent factors have been evaluated.
In 348 of 392 cases with lung cancer who were treated by local irradiation between January 1989 and January 1992 the patient's records were evaluable for response and toxicity. All patients were treated by megavolt equipment with a conventional fractionation in most cases. Standard target volumes were irradiated including the lymphatic drainage. From a dose of above 30 Gy a technique sparing the spinal cord was chosen. Retrospectively pneumonitis was classified into 4 grades starting from slight symptoms to respiratory insufficiency requiring O2. Grade I and II were summarized to slight, grade III and IV to severe pneumonitis.
Regarding the treatment prior to irradiation patients with primary irradiation were affected in 26.5% (17% slight, 9.5% severe), with postoperative irradiation in 14% (9.3% slight, 4.7% severe), with radiochemotherapy of small cell lung cancer (SCLC) in 15.4% (12% slight, 3.4% severe) by this side effect. These differences were not significant (p = 0.32). The median onset of pneumonitis was 31 days after end of irradiation (severe 23 days, slight 44 days, p = 0.026). By a univariate analysis the total dose at the prescription point was the most important factor (30 to 50.5 Gy 11%, 52 to 59 Gy 15%, 60 to 74 Gy 26%, p = 0.007). High single doses (2.5 Gy) were only applied within a study of radiochemotherapy with a randomised sequential and alternating schedule. So that the increased rate of pneumonitis (42%) is not clearly separable from other influencing variables. A correlation between the applied techniques and the irradiated volume (measured by planimetric methods) was not demonstrable. Regarding the independent factors a high age, female sex and a low FeV1 were unfavourable. However, age and sex corrected FeV1 was not predictive.
The observed incidence is within the range of literature. By a clinical point of view the total dose is an obvious factor. Also single doses above 2 Gy have to be seen critically (a total dose of 50 Gy). The results confirm the fact that patients with a low FeV1 are not suitable to a high dose irradiation of the chest. In this connection old patients and women also should be seen as patients at risk.
肺癌放疗中最重要的副作用是肺炎。在海德堡大学患者群体的一项回顾性研究中评估了肺炎的发生率。对与治疗相关和与治疗无关的因素进行了评估。
在1989年1月至1992年1月期间接受局部照射治疗的392例肺癌患者中，有348例患者的记录可用于评估反应和毒性。大多数情况下，所有患者均采用兆伏设备进行常规分割治疗。照射标准靶区，包括淋巴引流区。当剂量超过30 Gy时，选择脊髓保护技术。回顾性地将肺炎分为4级，从轻微症状到需要吸氧的呼吸功能不全。I级和II级合并为轻度，III级和IV级为重度肺炎。
关于放疗前的治疗情况，接受初次放疗的患者中26.5%受到该副作用影响（轻度17%，重度9.5%），接受术后放疗的患者中14%受到影响（轻度9.3%，重度4.7%），接受小细胞肺癌（SCLC）放化疗的患者中15.4%受到影响（轻度12%，重度3.4%）。这些差异无统计学意义（p = 0.32）。肺炎的中位发病时间为放疗结束后31天（重度23天，轻度44天，p = 0.026）。单因素分析显示，处方点的总剂量是最重要的因素（30至50.5 Gy为11%，52至59 Gy为15%，60至74 Gy为26%，p = 0.0
